Cambridge Brain Tumor Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
Department of Neurosurgery, Shanghai General Hospital (originally named "Shanghai First People's Hospital"), Shanghai Jiao Tong University School of Medicine, China.
Neurosurgery. 2019 Oct 1;85(4):524-534. doi: 10.1093/neuros/nyy388.
Glioblastoma is a heterogeneous disease characterized by its infiltrative growth, rendering complete resection impossible. Diffusion tensor imaging (DTI) shows potential in detecting tumor infiltration by reflecting microstructure disruption.
To explore the heterogeneity of glioblastoma infiltration using joint histogram analysis of DTI, to investigate the incremental prognostic value of infiltrative patterns over clinical factors, and to identify specific subregions for targeted therapy.
A total of 115 primary glioblastoma patients were prospectively recruited for surgery and preoperative magnetic resonance imaging. The joint histograms of decomposed anisotropic and isotropic components of DTI were constructed in both contrast-enhancing and nonenhancing tumor regions. Patient survival was analyzed with joint histogram features and relevant clinical factors. The incremental prognostic values of histogram features were assessed using receiver operating characteristic curve analysis. The correlation between the proportion of diffusion patterns and tumor progression rate was tested using Pearson correlation.
We found that joint histogram features were associated with patient survival and improved survival model performance. Specifically, the proportion of nonenhancing tumor subregion with decreased isotropic diffusion and increased anisotropic diffusion was correlated with tumor progression rate (P = .010, r = 0.35), affected progression-free survival (hazard ratio = 1.08, P < .001), and overall survival (hazard ratio = 1.36, P < .001) in multivariate models.
Joint histogram features of DTI showed incremental prognostic values over clinical factors for glioblastoma patients. The nonenhancing tumor subregion with decreased isotropic diffusion and increased anisotropic diffusion may indicate a more infiltrative habitat and potential treatment target.
胶质母细胞瘤是一种具有浸润性生长特点的异质性疾病，使得完全切除成为不可能。弥散张量成像（DTI）在反映微观结构破坏方面具有检测肿瘤浸润的潜力。
使用 DTI 的联合直方图分析来探索胶质母细胞瘤浸润的异质性，研究浸润模式相对于临床因素的增量预后价值，并确定用于靶向治疗的特定亚区。
共前瞻性招募 115 例原发性胶质母细胞瘤患者进行手术和术前磁共振成像。在增强和非增强肿瘤区域中构建 DTI 的分解各向异性和各向同性分量的联合直方图。使用联合直方图特征和相关临床因素分析患者的生存情况。使用接收者操作特征曲线分析评估直方图特征的增量预后价值。使用 Pearson 相关检验测试扩散模式比例与肿瘤进展率之间的相关性。
我们发现联合直方图特征与患者生存相关，并改善了生存模型的性能。具体而言，非增强肿瘤亚区中各向同性扩散降低和各向异性扩散增加的比例与肿瘤进展率相关（P =.010，r = 0.35），影响无进展生存期（危险比= 1.08，P <.001）和总生存期（危险比= 1.36，P <.001）在多变量模型中。
DTI 的联合直方图特征显示出比临床因素对胶质母细胞瘤患者的增量预后价值。各向同性扩散降低和各向异性扩散增加的非增强肿瘤亚区可能表明具有更浸润性的生态位和潜在的治疗靶点。
